RESEARCH ARTICLES

Labor accidents and the families' experience from the victims' standpoint

Ana Patrícia Araújo Torquato Lopes^I; Pâmela Brogin^II; Pâmela Yumi Watanabe Hirata^III; Cinthia Lopes Barboza ^IV; Adriano Brischiliari^V; Maria das Neves Decesaro^VI

^I Nurse. PhD student. Department of Nursing, State University of Maringá. Paraná, Brazil. E-mail: anaptorquato@hotmail.com
^II Nurse. Resident. University of São Paulo, Cardiovascular Nursing, Dante Pazzanese Institute of Cardiology. Sao Paulo, Brazil. E-mail: pamela.pops@hotmail.com
^III Nursing Student. Department of Nursing, State University of Maringá. Paraná, Brazil. E-mail: pam.yumi@hotmail.com
^IV Nurse, Master, Collaborator Professor, State University of Maringá. Paraná, Brazil. E-mail: ciloba@hotmail.com
^V Nurse. Doctoral student. Department of Nursing, State University of Maringá. Paraná, Brazil. E-mail: adriano.enfermeiro@hotmail.com
^VI Nurse. Doctor. Department of Nursing, State University of Maringá. Paraná, Brazil. E-mail: mndecesaro@uem.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.11593

ABSTRACT

Situations experienced at work may be traumatic and consequently affect the physical and mental health of those injured. This quantitative and qualitative descriptive study aimed to apprehend aspects of the families' experiences in the victims' views. Data were collected from March to August 2013 in two stages: first, 212 Workplace Accident Notifications filed at Maringá University Hospital in 2012 were examined; later, a semi-structured questionnaire was applied to 16 victims absent from work for 30 days or more. The study identified, from the victims' standpoint, the difficulties experienced by the family group; the changes arising from the accident; the feelings revealed with regard to the accident; and the expressions of human solidarity. It was concluded that family support is important, given the changes that result from the accident, requiring day-to-day reorganization to address the difficulties, which are primarily financial.

Keywords: Family; family relations; occupational accidents; occupational health.

INTRODUCTION

Work is considered something inherent to the human evolutionary functioning, proper to life, constituted in the midst of mankind's education processes. Thus, think of work in some contextualizations means to articulate it to naturalizing processes of constitution of the world and the human as to characterize it as part of human nature^1,2.

There are numerous situations experienced during the working day that may be considered traumatic and consequently impact the physical and mental health of victims. These situations, called work accidents, include: explosions, burns, electric shock, robberies, assaults, industrial accidents, amputation of limbs, among others^3,4.

Work accidents are the main harm to the health of workers, with high social and economic costs of up to 10% of gross domestic product (GDP)⁵.

This study aimed to apprehend aspects of the experiences of families from the perspective of the victims.

LITERATURE REVIEW

Work accident and occupational disease and work disease are conceptualized; in this sense, accident at work are equivalent to: accident on the workplace that, though not consisting in the only cause, has contributed directly to the occurrence of the injury; accident suffered by the insured person at the workplace in working shift; disease from accidental contamination of the employee in the exercise of his/her activity; accident suffered on company business or on the way between home and the workplace, and vice versa, of the insured person⁶.

Under Social Security, work accidents refer to occupational diseases and injuries from external causes. When a typical accident, or an accident on the way to work, happens, or when there are symptoms of illness related to the labor process, it is necessary the company to make the notification through the occupational accident report (CAT) to the National Social Security Institute (INSS ), part of the Ministry of Social Security⁵.

The issue of CAT officially registers and recognizes the grievance and ensures the worker, depending on the case, the possibility of receiving accident or sickness aid. In addition, the information available on the CAT serves for studies of these grievances, allowing the design of prevention policies. During 2011, about 711,200 work accidents were registered in the INSS , revealing an increase of 0.2% compared to 2010, and also an increase of 1.6% in the records of CATs in 2011⁶.

During 2011, about 711,200 work accidents were registered in the INSS . Compared to 2010, the number of occupational accidents had an increase of 0.2%. The total number of accidents recorded through CAT increased 1.6% from 2010 to 2011. Among all accidents registered through CAT, typical accidents accounted for 78.6%; accidents on the way to work accounted for 18.6% and those due to occupational diseases, 2.8%. Males accounted for 75.3% and females for 24.7% of the typical accidents; 63.9% and 36.1%, respectively, of the accidents on the way to work; and 61.0% and 39.0%, respectively, of occupational diseases. The ten-year age group with the highest incidence of typical accidents and accidents on the way to work, with respectively 36.5% and 39.9% of all recorded accidents, was made up of people from 20 to 29 years. With respect to occupational diseases, the group with highest incidence was 30-39 years with 32.8% of all recorded accidents⁶.

METHODOLOGY

This was a descriptive, quantitative and qualitative study. The participants of this study were subjects who suffered work accidents and who met the inclusion criteria.

In the first phase, data collection was performed on all CAT of the University Hospital of Maringá (UHM) in the year 2012, a total of 212 cases. For the second phase, which is the present study, the following inclusion criteria were observed: leave from the job for 30 days or more due to work accident; person aged over 18 years; resident in a municipality belonging to the 15th Regional of Health of Paraná and inside an approximate range of 40 km away from the host city. Among the 212 injured, 24 subjects met the inclusion criteria for the 2nd stage of the study. After a phone contact explaining the objectives of the research, 16 injured persons agreed to participate, two refused and six were excluded due to incorrect/incomplete data in CATs. During the home visit, scheduled according to the availability of the respondent and his family, the objectives were clarified and participants were asked to sign the Informed Consent (IC). The research was conducted from March through August 2013.

In order to collect data, a semi-structured interview was held, following a script with questions developed by the researchers; these interviews were recorded and later transcribed for analysis of the reports.

The methodological principles of thematic content analysis according to the reference of Bardin⁷ was used for treatment of data. This which consists of three basic steps: pre-analysis, descriptive analysis and inferential interpretation. In pre-analysis, the material is organized to determine which documents will be submitted to the analysis and formulation of hypotheses for the development of indicators for final interpretation. During the analysis phase, the articles are subjected to in-depth study in which the text data are aggregated into categories of similar import. The inferential interpretation phase involves reflection and intuition to build relationships and expand future ideas. Four thematic units were composed based on the organization of data obtained in interviews, and these were analyzed and discussed with support from available health sciences literature.

This project was submitted to the Ethics Committee in Research with Human Beings - COPEP, of the State University of Maringá and approved under opinion nº 8,120, of 2012. According to the provisions of Resolution nº 466/12 of the National Health Council⁸, identification codes were used to ensure full anonymity of the injured interviewed subjects (I), followed by the serial number of data collection.

Based on the organization of participants' speeches, the following four thematic categories emerged: Difficulties experienced by the family group, according to the victims; changes arising as consequence of the accident; feelings revealed in face of the work accident; and the manifestation of human solidarity.

RESULTS AND DISCUSSION

Characterization of occupational accident reports

In 2012, there were 212 work-related accidents reported at the UHM. Among these, the type of accident that mostly affected workers was the typical work accident (84.91%), followed by the accident on the way to work (8.02%). Regarding the socio-demographic characteristics of workers, the reported cases revealed a predominance of males (79.72%), single (45.28%) and aged between 18 and 40 years (66.51%), and the age of the victims was never superior to 66 years.

Regarding the characteristics of accidents, these occurred mainly at the beginning of the working day - up to 4 worked hours (47.64%). By analyzing the situation generating the accident described in CATs, the following prevailed: contusion/crushing (39.67%), followed by fractures (38.04%).

Among the 212 workers, 139 (65.57%) did not need work leave for recovering of health. The other 73 (34.43%) needed a longer time for recovery, of which, 39 (53.42%) were removed for 31 to 60 days, 20 (27.40%) for 61 to 90 days, and 14 (19.18%) for over 90 days.

Difficulties experienced by the family group, according to the victims

Several difficulties were evident on the speech of the victims, and the most stressed were the bureaucratic difficulties, related to the INSS, and those related to health services, both in hospitals and emergency care on the day and place where the accident occurred. Financial difficulties were also mentioned, and difficulties related to meet the individual needs due to the physical trauma.

The accounts presented in this study make very clear that political and bureaucratic issues hamper the right to receive financial assistance due to accident at work, and this slowness interferes with the economic situation of the family:

Finances? Wow! Things got complicated in this meantime! [...] The bills piled up[...] I was 45 days getting zero money, it took some time to get it, I even had to expertise examinations before get it [...] it took almost a month, you know how are these things with the government. Every hired worker that depends on the salary know how difficult it is. (I3)

My salvation was that I had a little bit there saved in the bank, otherwise I would be in trouble, it was was a buck that helped keep me until I received from INSS and return to normal, I had to use the savings, otherwise I would not be able, because the cost of medicine today is absurd [...] the medicine cost 190 reals...200 reals [...] It was hard, INSS is complicated. (I16)

The reports show the influence of financial independence, the feeling of responsibility from the patriarch before the burden and social commitment to payment of debts. Clearly, relief comes from being able to count on economic reserves to go through that moment of financial distress.

Studies show the social importance of work, especially when the family provider is represented by the injured worker. The family is concern not only about the survival but also about the consequences and difficulties to bear the costs and the family subsistence, since the victim is often responsible for the household budget^9-12.

Another aspect of the difficulties that became evident in the reports relates to health care. This is related to the service and organization of hospitals and the emergency service on the day and place of the accident.

The day my accident happened, SAMU [Mobile Emergency Service] did not show up. I was 40 minutes on the avenue, where many trucks pass all the time, then was taken to a workshop and I waited another 40 minutes and the ambulance did not come. A cousin of ours was the one who came to pick me up. Arriving at hospital X, I waited three hours or more to be assisted, I was with pain and cold. (I5)

The moment of accident is characterized by pain, loss and stress. A delay in being assisted, even a few minutes can feel like an eternity for the person who is suffering, in pain and in a damage situation. This awakens us to reflections on the health teams.

Workers do not have autonomy neither delegated powers to maintain inter-institutional contacts. It is, however, the right of the worker to receive support from superior hierarchical instances while seeking to remedy conflicts and to enable formal or agreed understandings between companies, workers and public institutions in face of problem-situations^13-15.

The reports stress that the search for the SAMU is motivated by the speed and agility of service offered and also by the possibility to transport the user specifically to a service that corresponds to the health need of the person^16,17.

It is known that the lack of compliance with speed and competence reflect in possible physical harm to the person who suffers an accident at work, as shown by the testimonials.

[...] I could not move my left arm, could not bear to move his arm, my wife helped me do some things, like bathing, changing me out ... I was immovable for 135 days. (I1)

[...] I was hospitalized 15 days and they did not touch my clavicle. On the last day, when I was discharged from the hospital, they asked me to go to the orthopedist of the emergency room, it was when I took the x-ray. I returned after a month, scheduled another doctor and he said that my clavicle was broken and needed surgery, [...] I have not done it until today, I no longer lift my arm, the doctor ordered an ultrasonography, it is not ready yet. (I6)

The reports show that losses related to the physical of the victim are highlighted by the pain caused by the injury, hampering the development of activities of daily life, but they do not represent immediate serious consequences, but can lead to future complications.

Work accidents may ean the end of life of a worker, leading to loss and reduction of their working capacity due to disability or even death. Nevertheless, an aspect that must be considered is that the accident affects not only the physical of the victim, but also deeply affects human dignity because of the social value of work and the achievement of personal acomplishments^9,18,19.

There are numerous aspects that perpetuate the lack of social protection of a worker after an accident and make him/her subject to legal resolutive, regulatory and institutional current public organization. These workers come to attend a path of comings and goings cooperating for civil invisibility of the victims. This goes from the institutional bureaucracy (queues, call delay, lack of vacancies) forwarding of sickness with the INSS, creating a financial deficit until obstacles of recognition of individual health care needs due to trauma, showing disrespect towards this individual, resulting still in possible physical sequelae and interfering in socioeconomic situation of an entire family group.

Changes arising as consequence of the accident

The testimony showed distinct changes, particularly of the physical aspect because of the trauma as well as changes in relationships.

The main change that took place due to an accident at work is related to the physical of the person. Here are the reports:

My shoulder was back to normal, it is just that sometimes, [...] in rainny weather, it gives a hooked, and when I lie on the left side, I have to change the position. (I3)

My arm was stiff and I could not make movements [...] now it continues as normal, I just can not lift any weight, because I feel pain, I cannot close the hand, like, with strengh. (I5)

Some respondents make mention to the limitations imposed on their lives due to sequelae developed after the accident, leading to changes in their routine and of their families.

Functional disability for instrumental activities of daily living of a person involves various aspects of health condition. This may cause difficulties in carrying out these tasks and possible impairment in social interactions of the victims and their families^20,21.

Notably, in certain speeches denoted changes in family relations, labor relations, development of daily activities, changes in the victim's personal behavior. In others, the accident did not cause changes in family routine:

the routine of the family did not need to change, what I could do by myself, I would do it. (I1)

[...] I was the one used to take the lead in going after things, and then I had to stay stucked [because of the accident]. (I4)

After the accident I did not drink anymore, I used to drink before [...] since the accident, I quit. [...] The family became more united [...] You think you'll lose, then you become more united. (I8)

The accident was not a good thing, but it helped because today they (employees) are no longer doing what we used to do, things have changed [...] this work is risky. (I16)

These data corroborate studies that describe the disease generating changes in the routine of home, on behavior and family relations, generally raising the consolidation, the union and the alignment of all^11,19,22.

Positive and negative aspects were seen in face of the changes unleashed in the worker, in the family members and in the people living of the victim. With respect to the positive side, we see the familiar union and the changing of habits regarded as unhealthy such as smoking and drinking, which were overcome, and also the worry in guiding other people to be careful and attentive to theworking environment, raising the sense of importance of the correct use of personal protective equipment (PPE)²³.

Despite knowing that the injury caused by brain injury accident manifests much stronger sequelae than thos accompanied this research, it is important to reaffirm that the health care team work to help the injured personto expand his/hercapacity to understand and modify his/her behavior, improving social life^19,24.

Faced with the changes brought about by the unexpected accident of one of its members, the family group and the injured sought new forms of organization within the home and also social environment:

Thank God I have two sons who helped me a lot in the time I was away from work, I had no trouble with money, they work and help with the bills, in everything they can. (I1)

[...] Friends helped me taking me to school in their motobike or car, for me not to miss class. (I4)

Families passed through different changes, with need of reorganiz activities in the household and in the care of the injured person. Dependence from the care provided by the spouse, parents, children, or even grandparents or friends, is evident, mainly to meet their basic human needs of hygiene and nutrition.

Each family copes differently with adverse events. The importance of those who will work with families stands out, to know the uniqueness of each family, the mechanisms they find to face the situations that occur in everyday life experienced by them, and so allow recognition of strategies to help with the suffering before, during and after the event installed in the family context^22,25,26.

Feelings revealed

In this category, the victims expose feelings experienced at moment of the work accident and the trauma recovery process:

I was kind of complexed to return to work, afraid [...]. I was very ashamed of my finger, it turned black, I used tapes to hide the finger ... I did not want to go back to work. (I2)

Horrible, [...] God forbid, [...] my wife and my daughter were terrified. I get anxious when I stand still ... who besides me is suffering as well. (I8)

[...] The hand is just as important as the foot when I learned that he had broken it, I was very distressed [...] (I12)

The reports reveal feelings of the injured person and also of family members. It is evident, in the victim, the yearning in face the complex for the appearance or loss of a body part, shame and indignation; the psychological is changed, mainly by the fact of feeling impaired, useless, anxious, distressed and in fear before the possible consequences of an accident.

An accident leading to absence from work brings different losses to the injured person. There is a notable damage in personal and social acknowledgment, often being overlooked, undervalued and this induce the development of feelings of worthlessness and invisibility in the social environment. This pain interferes with self-esteem, increasing embarrassment and discomfort, insecurity, the decreased quality of life, stress, cognitive disorders, sleep disorders and possible depression. All of these elements reflect in the victim's life and in the life of people of part of his/her daily life, who usually are not prepared to deal with an unforeseen event^3,9,27,28.

Manifestation of human solidarity

In face of a work accident, human solidarity emerges in family members, in companies through employers, the neighbors and friends.

When she can, my mother helps me with the diaper of children ... The church brings food, we take, as posible. [...] Sometimes friends come here to give a help. (I15)

I work in the same company for 17 years [...] I'm already family, right? [...] They (employers) helped me, [...] a neighbor, when I needed to, would take my own car and take me where I wanted. (I16)

The help received at time of adversity, as at the accident, brings about the solidarity of people, as characterized in this study by the action of family, neighbors and friends. For some research subjects, the solidarity shown by co-workers or by employers leads them to consider the work environment as a complement of the family context.

The social support received by the victims, by companies and entities, have fundamental importance, equating to provide other professional services such as emergency mobile service, hospital care, social assistance by the INSS^3,27,28.

The value of daily life in contact with people stands out in maintaining emotional ties that provide the cohesion of the family through shared spaces, values ​​and ideas which are present on the mutual help of neighbors and friends, in charity actions, in the division of tasks and work, in the expression of affection and sensitivity of relations between cultures, races, religions and social classes^29,30.

CONCLUSION

The injured person faced various difficulties, especially with bureaucratic issues of INSS and consequent financial issues, as well as issues related to the organization of hospitals and the emergency mobile service.

The results allow us to observe the victims experience changes in various aspects of their work and family routine, as often these changes happen due to sequelae acquired after the work accident. The person experiences mixed feelings such as fear, shame, anxiety and distress, pointing injuries resulting from the accident and the relative inertia to absence from work and highlights the solidarity of family, friends and company, providing support for coping with difficulties and changes.

Thus, the findings of this study allow arguments liable for the prevention of accidents at work in companies. One limitation of this study was that it was found that many CATs were filled with incomplete or wrong address. It is worth mentioning the importance of correctly fill the data of workers in such document in order to contribute with the development of studies, analyses and interventions aimed at improving safety and working conditions.

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